Why does online therapy work in treating OCD?

Through our clinical research in OCD clinics in Malta, Italy, Ireland and France, we have found that online therapy is surprisingly effective for OCD patients and, in some ways, potentially more effective than conventional face-to-face treatment methods.

Yet when online therapy first emerged, many were hesitant to adopt it, questioning its effectiveness and efficiency. Everything changes with the pandemic. As the saying goes, “necessity is the mother of invention.” The Covid pandemic has led patients and professionals to use online therapy, challenging this idea, to overcome this limit.  

In fact, in the study, Giovanetti, et al, (2022) debunk myths about online options to recognize online therapy as a valid alternative to traditional face-to-face therapy. Their longitudinal study compared online therapy to traditional face-to-face sessions and found no significant differences in outcomes for a wide range of mental health problems, including depression and anxiety.

Wootton, BM, (2016) demonstrates that online therapy offers a number of significant benefits that make it a viable and accessible option for many people. Vitry, et al (2021) have assembled a large body of evidence supporting the effectiveness and efficiency of online therapy following a systems-strategic approach.  

OCD is very resistant to treatment

Obsessive compulsive disorder (OCD) is often considered a daunting life sentence by patients, but also by professionals who are not adequately trained to treat OCD. OCD symptoms can be very disturbing, cause significant distress, and impact daily life. Various research demonstrates that OCD is very resistant to change (Nardone, Portelli, 2005; Gibson et al., 2021). So the legitimate question is whether online therapy can work with OCD patients.

OCD and its variants are characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to stop the obsessive thoughts, which, paradoxically, are further fueled, causing the person to be caught in devastating vicious cycles, with apparently no way out. Considered impossible cases.  

Specialized OCD clinics apply the strategic and systemic approach in the treatment of OCD and its variants. Following the wisdom of the Palo Alto School (California) and the Centro di Terapia Strategica (Arezzo), OCD clinics in Malta, Italy, Ireland and France conduct ongoing clinical research to make therapy for OCD always more effective and efficient. Most OCD is fear-based, but there are variants that can be non-phobic, with anger, pain, or even pleasure as the dominant primary emotion or sensation. It is therefore necessary to carry out an in-depth diagnosis to understand its non-ordinary logic, in order to choose the most appropriate protocol and treatment.  

Challenges of traditional therapy for OCD:

Leaving home :

For people with OCD, compulsions to leave the house or fear of contamination can make traditional in-person therapy difficult. Patients with severe OCD find it too difficult to get to the clinic.  

Unfamiliar environments:

New environments can trigger anxiety in people with OCD, potentially hindering treatment progress. People suffering from OCD have difficulty leaving their familiar surroundings, which often become their "non-comfort zone".

Limited availability of specialists:

OCD specialists may not be available everywhere, limiting access to targeted treatment.

Missed appointments:

Patients often fail to attend therapy because they are sick, leave the office late, are stuck in traffic, don't have a babysitter to look after the children, etc. Patients must be monitored regularly and closely to stay on track and overcome obsessive thoughts and compulsive behaviors.  

Effective online therapy in OCD clinics

Consistent with the findings of Perini et al. (2009), who claim that expert-led online interventions enable meaningful clinical changes in patients, at the OCD Clinic we are investigating how to make online sessions more effective and efficient, particularly for the treatment of OCD . Our mission is to implement rigorous treatment protocols, scientifically validated and adaptable to the particularity of each case, in order to allow their patients to achieve the desired effective and efficient results, even with online therapy. Indeed, recent research has shown that online treatment is particularly effective with a strategic and systemic approach to various psychological problems (Vitry et al, 2021).  

Today it can be said that in some cases, such as depression (Karyotaki et al. 2018), anxiety disorders and OCD, the level of effectiveness of online therapy is even higher than in cases treated by traditional modalities (Giovanetti et al. 2022).

Benefits of Online Therapy for OCD:

Access to OCD specialists:

Online platforms connect patients with OCD specialists regardless of location. This helps expand treatment options and increases the likelihood of finding a therapist who specializes in OCD.

Increased accessibility:

Online therapy eliminates the need to travel, making treatment easier for OCD sufferers to access, regardless of their compulsions or location. With online therapy, there is no need to travel to the therapist's office. This means saving time and money, as well as greater flexibility to schedule sessions according to your needs. Sessions can be scheduled at unusual times, such as evenings or weekends, to best accommodate patients' personal and professional commitments.

Reduced anxiety and avoidance:

The familiar, comfortable environment of home can significantly reduce the anxiety associated with therapy sessions. This reduction in anxiety may facilitate communication and deeper exploration of OCD symptoms. For some people with OCD, going to a therapy appointment can be a trigger or source of anxiety. Online therapy removes this barrier and makes seeking help more convenient. This can be particularly helpful for people with OCD that focuses on social interactions or fears of contamination.

Flexible hours :

Online therapy offers greater flexibility in scheduling appointments. This allows people with OCD to tailor treatment to their compulsions and daily routine, minimizing disruption. Online sessions can take place at home, in the office, in the car and even abroad.

Improvement of the therapeutic alliance and compliance:

Online therapy provides a more familiar and comfortable environment, which can promote greater openness and sharing (Mallen et al 2005). The distance provided by being behind a screen reduces emotional involvement, which can give the patient a greater sense of protection, making exposure easier. Additionally, through the use of technology, the OCD therapist can monitor their clients closely. Patients can share their daily tasks and progress with their therapist, allowing them to feel more supported and motivated to combat obsessions and compulsions. The therapeutic alliance and compliance with therapy are strengthened.  

Close-ups increase concentration:

The video more clearly captures nonverbal language which can help the OCD therapist tailor the protocol to the patient. Many patients say that online sessions allow them to focus more on what they are saying and what the therapist is telling them. Even OCD therapists claim that online sessions help them to be more focused when carrying out their operational diagnosis and to understand how each task (action) informs the next task, in order to make further progress and consolidate the results. This is necessary to guide the OCD patient from occasional corrective emotional experiences toward second-order radical change.  

The exhibition in real situation:

Exposure to risk (fear of the dirty, of trouble, of mistakes, of hurting others or oneself, of misfortune, etc.). This involves gradually exposing patients to their triggers while resisting compulsions. Online therapy allows therapists to guide patients through exposure exercises in their own environment, where triggers are most likely to be present. Imagine someone with contamination OCD who struggles with doorknobs. In online therapy, the therapist can help her overcome the anxiety of touching an actual doorknob at home, rather than relying on a hypothetical scenario in an office.

Immediate and local support: 

Traditional therapy generally provides weekly or biweekly sessions. Online platforms allow for more frequent checks and even live coaching during exposure exercises. This helps provide the support needed in the moment when confronting triggers. In the case of OCD patients in particular, sessions must be regular to motivate change and consolidate results. Customers must be monitored closely to stay on track.

Testimonials:

Sarah, a 25-year-old with severe germ-related OCD, struggles to leave her home due to her fears of contamination. Online therapy allowed Sarah to begin therapy and receive effective treatment from an OCD clinic specialist from the comfort and safety of her own home, minimizing anxiety and facilitating progress . Online therapy allowed Sarah to receive therapy from home, where she felt safe and less anxious. This calmer state allowed him to focus on treating his OCD symptoms more productively.  

Sarah attended therapy online until she was able to leave the house and met her therapist at a seminar at the OCD clinic. 

Robert, a 30-year-old man, suffers from OCD characterized by prevention and repair rituals triggered by his excessive concern for perfection. Online therapy allowed the therapist to understand the obsessive order that Robert had locked himself into, guiding him to insert small disturbances into his obsessive order. Robert proudly shared his troubles with his OCD therapist on video. This helped him to be more motivated to complete the tasks assigned to him.   

Sani, a 20-year-old student living in Dubai, struggled to find a qualified OCD therapist nearby. She underwent numerous therapies, but without success, for her obsessive and compulsive behavior. Through online therapy platforms, Sani came into contact with an OCD specialist in Malta. Sani was thus able to benefit from evidence-based treatment, despite limited local resources.

In summary, as well as being a versatile and convenient option for many people seeking support for mental health issues, online therapy offers a number of significant benefits for people with OCD, including accessibility , cost reduction, comfort, confidentiality, flexibility and access to a specialized and experienced OCD therapist. 

Our ongoing clinical research shows that online therapy increases the therapeutic alliance and therapy adherence. Online therapy offers significant benefits for OCD because it takes into account individual needs and difficulties related to the OCD problem. By overcoming the challenges associated with traditional therapy, online platforms can facilitate significant progress in managing OCD symptoms and improving quality of life, more effectively and efficiently.  

Yet in OCD clinics, work is still underway.

Here are some resources you can explore for more details:

* **"[ https://www.treatmyocd.com/ ( https://www.treatmyocd.com/ ) "** This article from the International OCD Foundation discusses the benefits of online therapy for treating OCD.

It's important to remember that online therapy is not suitable for everyone with OCD, especially those with severe disorders. However, for many, it is a valuable and effective treatment option.  

Training in brief systemic and strategic therapy 

LACT offers several live certified web training courses with 50 international trainers:

• Generalist systemic training
• DU relationship clinic with the University of Paris 8
• Clinical Master of Giorgio Nardone LACT/CTS
• Systemic Coach Training

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